A Randomised Control Trial Comparing Opioid and Paracetamol for Pain Control after Carpal Tunnel Release

Background: Opioids are frequently used for pain control after carpal tunnel release (CTR). However, few studies have examined whether the use of opioids is necessary for pain control after CTR. The aim of this study is to compare the effectiveness of codeine versus paracetamol for pain control after CTR. Methods: This is a prospective comparison of consecutive patients' subjective perception of pain after outpatient CTR. Patients were randomised to receive either codeine or paracetamol for pain control after CTR. Visual analogue scale for pain of both groups was compared on the day of surgery and the first three post-operative days (POD) using non-inferiority test. Results: In the codeine group, the mean pain score was 5.2, 4.0, 2.6 and 1.6 on the day of surgery and the first, second and third days after surgery, respectively. In the paracetamol group, the mean VAS score in the same period was 4.3, 3.5, 2.8 and 2.3. There was no significant difference in the mean visual analogue pain scores between the two groups from the day of surgery to the third POD. Conclusions: Paracetamol was as effective as codeine for relieving the pain after outpatient CTR. Our results suggest that the clinicians might avoid unnecessary prescription of the opioid after outpatient CTR. Level of Evidence: Level III (Therapeutic).